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Vaccinations are among the best defenses we have against serious, potentially deadly diseases — and they’re especially important for people with chronic health conditions like the human immunodeficiency virus (HIV), according to the Centers for Disease Control and Prevention (CDC).

If you have HIV, the type of vaccination you should get depends on whether your CD4 cell count — the prime indicator of immune system status in people with HIV — is 200 or above, or below 200.

“Live vaccines aren’t recommended if you have a CD4 count under 200,” says Anna Wald, MD, MPH, a professor in the division of allergy and infectious diseases at the University of Washington, in Seattle. A CD4 count of less than 200 brings up two main issues. “We worry about whether the vaccines are safe, but also whether a patient’s immune system can respond,” Dr. Wald says. “In people who need vaccinations, we often like to start them on antiretroviral therapy, wait for their CD4 count to rebound, and then vaccinate them, because their immune system is stronger. Ultimately, it depends on how urgently they need the treatment.”

Here are some additional facts to keep in mind before you get vaccinated.

Live Vaccinations

“Most vaccines given in the United States are not live vaccines,” says Wald. “Instead, they’re either inactivated or subunit vaccines, which means they contain only part of the virus or bacterium and cannot cause disease.” And since most HIV-infected Americans are adults (children are rarely born with the disease anymore), this makes live vaccines less of a concern. Still, there are some outliers, including the herpes zoster, or shingles, vaccine.

Shireesha Dhanireddy, MD, the director of the University of Washington Medicine’s Infectious Diseases Clinic and the assistant medical director of the Madison Clinic, is questioned most often about the shingles vaccine. This live vaccine, while approved for individuals over the age of 50, is recommended for individuals over 60 who have a significantly higher risk of herpes zoster reactivation.

“In patients with CD4 counts less than 200, it’s [not recommended], while in patients with CD4 counts higher than 200, there’s currently no recommendation,” says Dr. Dhanireddy. So what does this mean for you? If you’re HIV positive and have a CD4 count above 200, your doctor can decide whether you should get the vaccine. “Some providers are giving it to patients who have good CD4 counts and are over 60, but many aren’t,” Dhanireddy says. The reason is that these providers are waiting for a new, nonlive herpes zoster vaccine to become available. Then “we’d be able to give this vaccination to all individuals,” Dhanireddy says. “The question would then become at what age to start [vaccinating people], because HIV itself is a risk factor for earlier shingles reactivation.”

Vaccines Recommended for People With HIV

People with HIV may need to get certain vaccinations that many HIV-negative people don’t. These include the meningococcal vaccine and hepatitis B vaccination.

Meningococcal vaccine. A relatively new recommendation for those with HIV is the meningococcal vaccine; data has suggested that people with HIV may be more likely to develop meningitis, a life-threatening disease.

Hepatitis B vaccination. If people with HIV get hepatitis B, they can have a higher risk of accelerated liver disease and cirrhosis.

CDC Recommendations for HIV-Positive Adults

According to the CDC, the following vaccinations are recommended for those with HIV, depending on their current health and viral load. Talk to your doctor before you schedule any vaccinations.